What is radiocontrast induced nephropathy?
What is radiocontrast induced nephropathy?
Contrast-induced nephropathy (CIN) is defined as the impairment of kidney function—measured as either a 25% increase in serum creatinine (SCr) from baseline or a 0.5 mg/dL (44 µmol/L) increase in absolute SCr value—within 48-72 hours after intravenous contrast administration.
What is the mechanism of contrast induced nephropathy?
The pathophysiology of contrast-induced nephropathy (CIN) is based on three distinct but interacting mechanisms: medullary ischaemia, formation of reactive oxygen species and direct tubular cell toxicity. The contribution of each of these mechanisms to the development of CIN in the individual patient remains unclear.
How does contrast media cause acute kidney injury?
Post-contrast AKI emphasizes the temporal relationship between contrast exposure and AKI. In experimental studies, it is clearly proven that contrast agents reduce renal blood flow in the medulla, induce free oxygen radicals, and induce apoptosis of renal tubular cells ( Figure 1) 3– 5.
What are symptoms of contrast induced nephropathy?
CIN is associated with a sharp decrease in kidney function over a period of 48-72 hours. The symptoms can be similar to those of kidney disease, which include feeling more tired, poor appetite, swelling in the feet and ankles, puffiness around the eyes, or dry and itchy skin.
How can radiocontrast induced nephropathy be prevented?
A variety of therapeutic interventions, including saline hydration, diuretics, mannitol, calcium channel antagonists, theophylline, endothelin receptor antagonists, and dopamine, have been used in an attempt to prevent radiocontrast-induced nephropathy.
How can contrast induced nephropathy be prevented?
The cornerstone of prevention of CIN is appropriate risk stratification, intravenous hydration with normal saline or sodium bicarbonate, appropriate withholding of nephrotoxic medications, use of low or iso-osmolar contrast media, and various intraprocedural methods for iodinated contrast dose reduction.
Is Contrast induced nephropathy real?
The risk of contrast induced nephropathy (CIN) is negligible in patients with normal renal function but the incidence appears to rise to as high as 25% in patients with pre-existing renal impairment or in the presence of risk factors such as diabetes, advanced age, vascular disease and use of certain concurrent …
How is contrast-induced AKI treated?
Contrast-Induced Nephropathy Treatment & Management
- Approach Considerations.
- Hydration Therapy.
- Statins.
- Bicarbonate Therapy.
- N-acetylcysteine.
- Renal Replacement Therapy.
- Other Therapies.
- Deterrence and Prevention.
How is contrast nephropathy treated?
A number of other therapies for CIN have been investigated, including the following:
- Sodium bicarbonate.
- N-acetylcysteine (NAC)
- Statins.
- Ascorbic acid.
- The adenosine antagonists theophylline and aminophylline.
- Vasodilators.
- Forced diuresis.
- Renal replacement therapy.
How common is contrast induced nephropathy?
CIN is the third most common cause of hospital acquired acute renal injury representing about 12% of the cases. The incidence of CIN varies between 0 and 24% depending on patient’s risk factors.
Despite extensive speculation, the actual occurrence of contrast-induced nephropathy has not been demonstrated in the literature. The mechanism of contrast-induced nephropathy is not entirely understood, but is thought to include direct damage from reactive oxygen species, contrast-induced increase in urine output,…
Is the use of radiocontrast related to kidney function?
Analysis of observational studies has shown that radiocontrast use in CT scanning is not causally related to changes in kidney function.
How is postcontrast related to acute kidney injury?
Given the increasing doubts about the contribution of radiocontrast to acute kidney injury, the American College of Radiology has proposed the name postcontrast acute kidney injury which does not imply a causal role, with CIN reserved for the rare cases where radiocontrast is likely to be causally related.
When to take atorvastatin for contrast induced nephropathy?
RRT – contrast media is removed by dialysis, but no evidence it works prophylactically and is invasive and labour intensive ( ref ). Atorvastatin — 80mg dose 24 hour prior to angiography prevented contrast-induced acute kidney injury in patients with mild to medium risk ( ref ). NB. All patients also received a high dose of NAC and NaHCO3